Global Neurology: Hot Topics in Global Neurology*

Despite continuing public health successes in the battle against malaria, the disease continues to kill hundreds of thousands of people annually. The most lethal syndrome of illness is cerebral malaria, clinically defined as an otherwise unexplained coma in someone with Plasmodium infection. Vaccines hold promise to decrease illness and severity, but are thus far hampered by incomplete protection and challenging administration schedules. As climate changes, it is likely that malaria will appear in new geographical locations, infecting those with little acquired immunity and with high mortality rates.

The presentation focuses on unprecedented grassroots activism by a group of neurologists to deliver anti-seizure medications to war-stricken Ukraine. The war and displacement quickly created many unanticipated needs, including access to medications which placed people with epilepsy at risk for serious injury and death. As the atrocities of war unfolded, the international community and individual citizens sprang into action to help Ukrainians. Relatively quickly, numerous NGOs and governmental agencies started working on critical access to food, shelter, medical supplies, medications, and other essential items. However, anti-seizure medications were not prioritized. This presentation highlights how motivated neurology and epilepsy providers came together to increase access to care and medications for vulnerable patients with neurologic diseases, which are not always prioritized during times of crisis. It covers the initial call-for-action from our Ukrainian colleagues, the challenges of procuring the anti-seizure medications and shipping them into a conflict region. 

The presentation will discuss the current state of neuroscience research in low middle income class countries, the opportunities and challenges for research development. Examples which highlight success stories and methods to build local research infrastructure will be presented. Proposals discussed during the proceedings of the research and innovation task force of the International League Against Epilepsy will be outlined and discussed.

Malaria affecting the central nervous system can present with coma (cerebral malaria – CM) or without (CNS malaria). CM affects 500,000 children annually, with neurodevelopmental sequelae in approximately 30%, including significant rates of epilepsy (10-16%). Available data suggest similar sequelae rates in the more common CNS malaria (a term referring to severe malarial infection with altered mental status or prolonged seizures but not frank coma), however it remains poorly understood whether CM is a severe subtype of CNS malaria, or is different pathophysiologically. We compared the two groups on clinical and EEG metrics on admission and 1-month follow-up. This talk will review our data that suggests that the two groups are more clinically similar than different, however with differences in qEEG suggestive of increased cortical dysfunction in CM. Long term outcomes still require investigation.